The purpose of this paper is to review important aspects in the treatment of accidental hypothermia, based on our own experience in rewarming 55 patients with severe accidental hypothermia and a core temperature <30°C. We used three different methods of re warming, adjusted to the patients' hemodynamics: airway rewarming, warmed fluids and insulation in patients with stable hemodynamics (group 1, n = 24), peritoneal dialysis in patients with unstable hemodynamics (group 2, n = 7) and extracorporeal circulation in patients with cardiocirculatory arrest (group 3, n = 24). Survival rates were 100% (group 1), 72% (group 2) and 13% (group 3) retrospectively. Published data supporting our strategy and alternative approaches are reviewed. The method used to rewarm a patient with severe accidental hypothermia should be adjusted to the hemodynamic status. The prognosis is excellent in patients in whom no hypoxic event precedes hypothermia and no serious underlying disease exists.